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Individuals admitted to the hospital with bloodstream infections who have been hospitalized in the preceding 90 days are more likely to have drug-resistant infections than those who acquired the infections in the community. This is most likely because hospital-acquired infections are often drug-resistant, notes Jay R. McDonald, M.D., of Duke University Medical Center.
Dr. McDonald and his colleagues examined microbiology laboratory records from October 16, 2000, through February 28, 2001, to identify patients with bloodstream infection at three North Carolina hospitals. The goal was to analyze the impact of health care-associated status on the effectiveness of therapy for bloodstream infections. They defined an infection as health care-associated if it occurred within the first 48 hours after hospitalization and if patients had one of the following characteristics: had received home health services, outpatient intravenous therapy, or outpatient renal dialysis in the 30 days prior to hospital admission; had been hospitalized within 90 days prior to admission; or lived in a long-term care facility.
For a total 466 bloodstream infections, 28 percent were community-acquired, 38 percent were health care-associated, and 33 percent were hospital-acquired (nosocomial). After accounting for multiple factors, health care-associated infections tripled the likelihood and nosocomial infections quadrupled the likelihood that initial antibiotic therapy would be ineffective.
Patients with nosocomial and health care-associated bloodstream infection received ineffective initial therapy (had drug-resistant infections) in 32 percent and 25 percent of episodes, respectively, compared with 8 percent of episodes for those with community-acquired bloodstream infection. Hospitalization in the 90 days prior to the current hospital admission was the component of health care-associated status that was most strongly associated with ineffective initial therapy. This research was supported in part by the Agency for Healthcare Research and Quality (T32 HS00079).
See "Risk factors for ineffective therapy in patients with bloodstream infection," by Dr. McDonald, N. Deborah Friedman, M.B.B.S., Jason E. Stout, M.D., M.H.S., and others, in the February 14, 2005, Archives of Internal Medicine 165, pp. 308-313.
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